Older people and technology: Time to smarten up our act.

The NHS faces challenges today that it was not designed to tackle at its conception in 1948. The UK demographic has changed considerably with higher life expectancy and 'an ageing population'. Keeping this demographic healthy through prevention and management of age-related degeneration is crucial to their independence and improving resource utilisation. The Department of Health and Social Care's agenda for digital transformation of the NHS is facilitating a move towards preventative healthcare and greater community care, which will likely be supported by virtual healthcare delivery models. Despite views on digital illiteracy in the older population, this demographic may stand to benefit the most. Research has shown that the older demographic adopts technology in line with the technology acceptance model if their needs are carefully considered. Executed successfully, the deployment of virtual healthcare could save transformational costs to the NHS and support better quality of life for the senior members of society. This is particularly relevant in the current COVID-19 pandemic with patients facing challenges in accessing outpatient appointments. With many hospitals kickstarting virtual outpatient clinics to ensure continuity of care during a time of social isolation; we await to see the ingenuities that arise from the current pandemic.

Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study.

BACKGROUND: An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS: Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS: Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS: Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Heads or tails: confusion about "proximal" and "distal" terminology for pancreaticobiliary anatomy.

BACKGROUND AND STUDY AIMS: The anatomical meaning of the terms "proximal" and "distal" in relation to the pancreaticobiliary anatomy can be confusing. We aimed to investigate practice patterns of use of the terms "proximal" and "distal" for pancreaticobiliary anatomy amongst various medical specialties. MATERIALS AND METHODS: An online survey link to a normal pancreaticobiliary diagram was emailed to a multispecialty physician pool. Respondents were asked to label various parts of the common bile duct (CBD) and pancreatic duct (PD) using the terms "proximal," "distal," "not sure," or "other." Variability in use of these terms between specialties was assessed. RESULTS: We received 370 completed surveys from 182 gastroenterologists (49.2 %), 97 surgeons (26.2 %), 68 radiologists (18.4 %), and 23 other physicians (6.2 %). There was overall consensus in describing the upper/sub-hepatic CBD as "proximal CBD" (73.8 %, P  = 0.1499) and the lower/pre-ampullary portion as "distal CBD" (84.6 %, P  = 0.1821). CONCLUSIONS: Although use of the terms "proximal" and "distal" is still very common to describe pancreaticobiliary anatomy, there is a discordance about its meaning, particularly for the PD. Use of descriptive terminology may be a more accurate alternative to prior ambiguous terminologies such as "proximal" or "distal" and can serve to improve communication and decrease the possibility of medical errors.

Celiac disease in an urban VA population with iron deficiency: the case against routine duodenal biopsy.

BACKGROUND: Celiac disease is considered an under-recognized cause of iron deficiency. Small intestinal biopsy is proposed to be part of routine evaluation for iron deficiency. AIMS: To determine the prevalence of celiac disease in an urban, mostly male, mostly minority population with iron deficiency. METHODS: Clinical, endoscopic, and pathologic records of veterans who had undergone esophagogastroduodenoscopy (EGD) and duodenal biopsy for iron deficiency at an urban, tertiary care Veterans Affairs Medical Center were reviewed. The yield of positive duodenal biopsies for celiac disease and pre-defined clinically important findings on EGD were calculated. Confounding factors were assessed in multivariate analysis. The main outcome measures were prevalence of celiac disease and prevalence of clinically important findings on upper gastrointestinal endoscopy. RESULTS: The records of 310 veterans were reviewed. Mean age was 63, range 32-91 years old. Most were male (89%) and African-American (73%). Five of 306 small intestinal biopsies were consistent with celiac disease (type 1 lesions), but tissue transglutaminase obtained in four of the patients was normal, making the prevalence of potential celiac disease 0.33% (95% CI: 0.06-1.83%). Fifty of 310 EGDs demonstrated findings that were considered to have a moderate or high probability of producing iron deficiency (16.1, 95% CI: 12.5-20.6%). CONCLUSIONS: The prevalence of celiac disease is low in an urban, predominately male, African-American population with iron deficiency. Routine small intestinal biopsy for celiac disease in similar populations should not be done. EGD remains clinically important.

Nonampullary duodenal polyps: characteristics and endoscopic management.

BACKGROUND: Guidelines for endoscopic resection and surveillance of nonampullary duodenal (NAD) polyps are still not well-defined. OBJECTIVE: To describe the characteristics of NAD polyps and evaluate the role of endoscopic management. DESIGN: Retrospective review. SETTING: Tertiary-care academic center. PATIENTS: This study involved 59 patients with NAD polyps. INTERVENTION: Endoscopic polypectomy, biopsy, and argon plasma coagulation. MAIN OUTCOME MEASUREMENTS: Complete polypectomy, complications, and recurrence. RESULTS: Ninety-six endoscopies were performed. The mean patient age was 62.8 years. The mean (+/- standard deviation) polyp size was 17.2 mm +/- 1.6 mm. The mean follow-up time was 26 months. Most lesions were sessile, solitary, and located in the descending duodenum. The procedure most often performed was submucosal injection followed by snare polypectomy. Adenomas were found in 68% of lesions overall and in 84% of lesions >2 cm. Successful resection was accomplished in 93% of cases on the initial attempt. Multiple endoscopies were needed in 5% of cases. The overall complete resection rate was 98%. Recurrence was documented in 37% of cases. Complications occurred in 5.2% of patients. Polyps of >2 cm were associated with higher rates of adenoma and a higher incidence of recurrence. Colon adenomas were found in 53% of patients with duodenal adenomas. LIMITATIONS: Retrospective review. Not all patients underwent colonoscopy. CONCLUSION: NAD polyps were large, sessile, and more commonly found in the second portion of the duodenum. They are more likely to be adenomatous when the lesion size is >2 cm. Despite successful endoscopic management, over one third of lesions demonstrated recurrence.